A group of Democratic lawmakers wants to use the immigration reform debate to fix one of the most hotly contested aspects of the health care law — provisions that bar immigrants from using new government programs to get coverage.

The move by the Congressional Hispanic Caucus would add a contentious new element to an already monumental task — passing a bill that puts 11 million illegal immigrants on a path to citizenship.

But the lawmakers say they’re merely following through on a pledge they made when the health care overhaul passed in March, and they expect the White House and Democratic leadership to do the same.

Some members of the caucus almost withheld their votes for health reform over what they saw as punitive, anti-immigrant measures in the bill, which bans illegal immigrants from using newly created exchanges to buy insurance, even with their own money, and maintains a five-year waiting period for legal residents to enroll in Medicaid.

They signed on only after receiving assurances that their concerns would be rectified as part of the immigration reform battle, according to lawmakers, advocates and Hill aides.

“The expectation was that everybody knew it was unfair and that a new immigration bill would correct that,” Rep. Raul Grijalva (D-Ariz.) told POLITICO.

Asked at what level he received such signals, Grijalva said: “High enough to feel secure about it.”

“There was a widespread sense in the community that immigrants were thrown under the bus in health care reform, and there was a sense that there would be a moral obligation to undo some of the damage,” said Deepak Bhargava, executive director of the Center for Community Change, an immigrant rights advocacy group.

But mixing two of the most controversial pieces of legislation backed by President Barack Obama — health care and immigration — could complicate immigration reform’s already tenuous chances, raising difficult political and policy questions about when this group of future citizens can receive benefits.

One of the main conservative talking points against the health care bill was that it would cover illegal immigrants — that’s what led to South Carolina Rep. Joe Wilson’s “You lie!” outburst to Obama, who said they were never covered under the bill. Now Republicans say any attempt to ease immigrants into the system would prove the GOP was right.

“Earlier this year, the president reassured the American people that illegal immigrants would not be covered by his government takeover of health care,” said Rep. Lamar Smith (R-Texas), ranking member of the House Judiciary Committee. “Now we see what he means. He intends to give millions of illegal immigrants amnesty in order to give them access to America’s health care system. In other words, the president and congressional Democrats are trying to get illegal immigrants into the health care system through the back door.”

Then there’s the issue of cost. No lawmaker is advocating giving illegal immigrants the right to government subsidies to buy insurance. That benefit would come only after immigrants gain legal permanent resident status, a process that could take at least six years and would come only after they register, pay fines, pass background checks and learn English.

But in that time, Congress would have to come up with billions of dollars to cover newly legalized residents — a cost that could blow a hole in Obama’s projections that health reform would reduce the deficit in the long run, one of his main rationales for the law.

“It makes their argument harder, no question about it,” said Rep. Steve King (R-Iowa), a vocal opponent of legalization. “We can’t afford it for a lot of reasons.”

The more immediate target for advocates is one that would not hit up taxpayers. Late in health reform negotiations, Democrats banned illegal immigrants from buying coverage in the exchanges with their own money — a move aimed at insulating the party from political attacks but one that deeply angered Hispanics.

To Democrats, the issue is undebatable: Once undocumented immigrants move into a temporary protected legal status — which they would gain after a bill passes and while they apply for citizenship — the exchanges would open up to them because they would no longer be illegal.

“Clearly, if they have status for a period of time, even if it is a pending status, they are no longer an undocumented immigrant and therefore they could, for example, purchase insurance with their own money,” Sen. Robert Menendez (D-N.J.) said.

House Speaker Nancy Pelosi (D-Calif.) agrees it should be a nonissue. “Once Senate Republicans stop obstructing comprehensive immigration reform and it becomes the law of the land, those who become citizens or legal residents will have access to the exchange,” her spokesman Nadeam Elshami said.

But some advocates don’t want to stop there.

Arguing that immigrants shouldn’t be consigned to second-class legalization, proponents say they will try to relax other restrictions, including lifting the five-year waiting period for legal residents to sign up for Medicaid, which was vastly expanded under the health care law.

Some advocates also argue that since immigrants will most likely be mandated to buy coverage under a temporary legal status, they should be eligible for the tax credits immediately.

“If we want newly legalized immigrants to bear equal responsibilities, they must have equal opportunities to meet those responsibilities,” said Jon Blazer, an attorney with the National Immigration Law Center.

Grijalva and advocates say they will push hard for these changes, but even some of the staunchest supporters of immigration reform, such as Rep. Luis Gutierrez (D-Ill.), acknowledge that the political environment will make it difficult.

Still, they say Obama set the stage last year for this push to make sure that current illegal immigrants become legalized and receive benefits.

“Even though I do not believe we can extend coverage to those who are here illegally, I also don’t simply believe we can simply ignore the fact that our immigration system is broken,” Obama told the Congressional Hispanic Caucus Institute in September 2009. “That’s why I strongly support making sure folks who are here legally have access to affordable, quality health insurance under this plan, just like everybody else.”

An administration official rejected the notion that Obama made any agreement beyond pledging to push an immigration overhaul.

Such a move would put millions of immigrants in the position to claim subsidies or enroll in Medicaid. Eighty-six percent of adult illegal immigrants fall under the income cutoff to receive assistance, which is less than $88,000 annually for a family of four, according to the Migration Policy Institute.

A legalization program would boost tax revenue by as much $5.4 billion in the first three years, according to the Center for American Progress. But the insurance credits could far outweigh revenue, given that half of adult illegal immigrants fall at the lowest end of the income ladder, making them eligible for more generous assistance.

Gutierrez could not recall any specific commitments made during his discussions with the president but that the issue would need to be addressed.

“It was more, ‘We’re going to take care of this in comprehensive immigration, people’s access to health care,” Gutierrez said. “You cannot do comprehensive immigration reform unless you deal with what the responsibilities of these new Americans are but also what the responsibility of the government is to them.”

“To say more is to just get a headline tomorrow, ‘Oh, Gutierrez wants them to have health care, and it’s going to cost billions of dollars.’ That is all we get out of it,” he said. “So I’ll cross that bridge; we’re going to have to deal with it.”